Download Diagnosis of Streptococcal Tonsillopharyngitis Author`s response

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Diagnosis of Streptococcal
Tonsillopharyngitis
Dear Editor,
I read the study titled "The sensitivity and specificity of
rapid antigen test in group A streptococcal tonsillopharyngitis" by Çoban et al. (1) with great interest. Çoban et al.
emphasized a prevalent issue in pediatric practice and
concluded that streptococcal tonsillopharyngitis was more
prevalent in children than in adults and it was important
since it might cause acute rheumatic fever. Another factor
that makes this disease significant is that it is an infectious
disease for which antibiotics are used frequently.
Streptococcal tonsillopharyngitis is only seen in humans,
and the only source of host and infection is humans. Many
subtypes with regards to M protein have been defined.
Cardinal findings in clinics are fever, sore throat, exudative
tonsillitis and cervical lymphadenopathy. Maculopapular
skin rashes, petechias in soft palate and scarlet fever may
accompany. It is the most important bacterial agent leading
to post infectious syndromes. Acute rheumatic fever, post
streptococcal glomerulonephritis, Sydenham chorea and
PANDAS syndrome are the main ones. Clinical findings are
essential in the diagnosis of streptococcal tonsillopharyngitis. After the evaluation of clinical findings, it makes the clinical diagnosis of streptococcal approximately tonsillopharyngitis with 70-75% (2). Precise diagnosis is made with
throat culture positivity. However, the fact that it takes
24-48 hours is the biggest disadvantage. Throat culture
leads us to diagnosis with the possibility of 96%. In order to
reduce the test time in throat culture, quick antigen tests
have been developed. As far as the results of the national
and international studies are concerned, the sensitivity of
quick test is between 60-70% (3). If the clinical findings are
in harmony with streptococcal tonsillopharyngitis and quick
test is positive, penicillin treatment should be started immediately. If the quick test is negative, the result of throat culture should be expected. It was found in Çoban et al.’s (1)
study that the sensitivity of quick diagnosis test of the 2163
cases was 68.1% and specificity was 92.2%. While falsenegative rate of the test was 31.9%, false-positive rate was
as low as 7.8%. While these values may be helpful in the
early diagnosis of quick streptococcal test, in case of negativity, it supports the fact that the results of throat culture
should be expected. Sufficient number of cases makes this
study more valuable. This test is effective in reaching the
diagnosis of streptococcal tonsillopharyngitis in the hospital
where it is used.
Emin Ünüvar, MD
Department of Pediatric Diseases, İstanbul University
Faculty of Medicine, İstanbul, Turkey
Çapa 34300 Istanbul
Phone: +90 536 359 95 26
E-mail: [email protected]
Letter to the Editor
References
1. Çoban B, Kaplan H, Topal B, Ülkü N. The sensisivity and specificity of rapid antigen test in group A streptococcal tonsillopharyngitis. J Pediatr Inf 2013; 7: 143-6. [CrossRef]
2. Tanz RR, Gerber MA, Kapat W, et al. Performance of a rapid
antigen- detection test and throat culture in community pediatric offices: Implications for management of pharyngitis.
Pediatrics 2009; 123: 437-44. [CrossRef]
3. Gürol Y, Akan H, İzbırak G, et al. The sensitivity and specificity
of rapid antigen test in streptococcal upper respiratory infections. Int J Pediatr Otorhinolaryngol 2010; 74: 591-3. [CrossRef]
Author’s response
Dear Editor,
We would like to thank dear Dr. Emin Ünüvar for his
interest in and contributions to our study.
Group A streptococcal (GAS) tonsillopharyngitis comprises 20-30% of all sore throats. Appropriate antimicrobial
treatment is crucial for the prevention of acute rheumatic
fever and other suppurative complications. The throat
wipe sample is essential for diagnosis through quick antigen test and/or GAS search with culture (1). Given the fact
that most of the primary care physicians and some hospital physicians do not have the possibility of microbiologic
tests, evaluation of clinical findings is still important for the
diagnosis of the disease.
In the most commonly used Centor scoring, lack of
coughing, age of 3-14, presence of tumor or tender
lymphadenopathy, temperature over 38 degrees centigrade, exudative or hypertrophic of swelling tonsils get one
point. Antibiotic is recommended for score 4 or over (2).
Estimated positive predictive value of 4-point in scoring
has been calculated as 48%; even this scoring does not
sufficiently prevent the inappropriate use of antibiotics (3).
More practical, applicable, catchy, new guidelines and
approach schemas for diagnosis are needed. Increasing
the laboratory facilities will also minimize the inappropriate
use of antibiotics.
Best regards.
Bayram Çoban, MD, Burhan Topal, MD
Başkent University, Alanya Training and Research
Hospital, Antalya, Türkiye
Phone: +90 532 511 87 87
E-mail: [email protected]
DOI:10.5152/ced.2014.1421
References
1. Schulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases
Society of America. Clin Infect Dis 2012; 55: 86-102. [CrossRef]
2. Regoli M, Chiappini E, Bonsignori F et al. Update on the management
of acute pharyngitis in children. Ital J Pediatr 2011; 37: 10. [CrossRef]